Comparison of Braided and Nonbraided Hamstring Tendon Grafts in ACL Reconstruction: Impact on Graft Thickness, Rerupture Rates, and Clinical Outcomes

Purpose: To compare braided and nonbraided hamstring tendon grafts in anterior cruciate ligament (ACL) reconstruction, specifically examining graft thickness, rerupture rates, and clinical outcomes, in order to assess whether braided grafts offer measurable advantages. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 154 patients who underwent single-bundle ACL reconstruction between January 2017 and October 2022. Patients were divided into braided (n = 78) and nonbraided (n = 76) hamstring autograft groups. Graft diameter was measured intraoperatively at the midportion using calibrated sizing tubes after standardized preconditioning. The cohort was predominantly male (92.2%). Primary outcomes included graft diameter, rerupture rates, and Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Lysholm score at baseline and 6, 12, and 24 months. Comparative analysis used the Mann-Whitney U test for continuous data and Fisher exact test for categorical data. Kaplan-Meier curves were used descriptively to illustrate rerupture-free survival. Results: Braided grafts showed a greater mean diameter (9.39 ± 0.63 mm) compared with nonbraided grafts (8.87 ± 0.74 mm) ( P < .001) and a numerically lower rerupture rate (2/78 2.6% vs 6/76 7.9%); however, this difference did not reach statistical significance (Fisher exact test, P = .16; fragility index = 1). Functional outcomes (KOOS, IKDC, Lysholm) improved over time in both groups, with no statistically significant between-group differences at 2 years. Conclusion: Braided hamstring tendon grafts reliably achieved increased graft thickness, whereas the lower rerupture rate was numerical only, was not statistically significant, and was statistically fragile. Braiding can be considered an intraoperative option to optimize graft diameter without compromising clinical outcomes, but the findings should be interpreted as exploratory.